Assistant Director Risk Adjustment Operations

Cambia Health Solutions•Medford, OR

7d•$113,780 - $187,737•Hybrid

About The Position

This is a hybrid role (3 days/week in office) at our Portland, Medford, Fargo, Burlington, Spokane, Vancouver, Renton, Boise, Lewiston or Salt Lake City offices. Candidates must reside within commutable distance of that location. The Assistant Director Risk Adjustment Operations is responsible for the management and oversight of the Risk Adjustment function supporting Health Plan Government Programs and applicable Commercial Lines of Business. Specific areas of responsibility include leading teams and vendors in: Quality Assurance and Compliance, Coding, Process and Analytics, and Campaign and Service Provider Management. – all in service of creating a person-focused health care experience.

Requirements

Bachelor's degree in business administration, health administration, finance or related field.
8-10 years of experience in healthcare insurance, Medicare or related programs, management consulting, or equivalent combination of education and experience.
FTEs Supervised 6 - 20
Demonstrated experience managing and leading a variety of healthcare (or related) operations functions and associated teams.
Knowledge of Medicare Advantage and/or Affordable Care Act rules and regulations, preferably with experience related to Risk Adjustment policies and best practices.
Ability to communicate effectively, verbally and in writing, across the organization from individual contributors to senior executives.
Ability to analyze complex situations and synthesize corresponding solutions, options, and action plans to staff.
Ability to coordinate cross-functionally to drive solutions and resolve issues in a timely and effective manner.
Demonstrated experience working with third-party service providers, building collaborative working relationships and teams, leading a matrix structure, and have an executive presence.
Must reside within commutable distance of the office location.

Nice To Haves

Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.

Responsibilities

Creates operational plans and leads teams to deliver high-value processes, analytics, data, tools and reporting to effectively achieve identified business objectives across Risk Adjustment.
Provides oversight and delivery of Risk Adjustment quality and compliance.
Develops and manages related audit processes and QA organization.
Accountable for delivering internal HCC coding production and quality.
Accountable for the delivery and oversight of Risk Adjustment Campaign results and quality, service provider Service Level Agreements (SLAs), and operational reporting.
Leads activities, relationships and issue resolution with third-party service providers.
Regularly communicates organizational objectives and team goals.
Monitors results and metrics to ensure deliverables are met and compliant with department and regulatory standards.
Collaborates with other leaders and across departments to resolve issues.
Handles all management level responsibilities for staff, including performance reviews, employee development, hiring, firing, coaching, counseling, and retention.
Develops managers and supervisors and participates in talent management activities.
Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources and oversees project plans.
In conjunction with division leadership, establishes long term goals for the department and adapts operational plans as changes occur.

Benefits

Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
Annual employer contribution to a health savings account.
Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
Award-winning wellness programs that reward you for participation.
Employee Assistance Fund for those in need.
Commute and parking benefits.
Competitive base pay
Market-leading 401(k) with a significant company match
Bonus opportunities